Soft tissue reconstruction of the foot after mine-explosion injury: a case report

A 22-year-old male sustained a high-energy blast injury after stepping on an anti-personnel mine during combat operations in eastern Ukraine, resulting in an extensive plantar soft tissue defect predominantly involving the central arch, while preserving critical weight-bearing structures, including the calcaneal tuberosity and metatarsal heads. The aim of this report is to describe a staged reconstructive strategy and evaluate the clinical effectiveness of prolonged negative pressure wound therapy (NPWT) combined with delayed split-thickness skin grafting for functional limb salvage in complex combat-related injuries. The patient was managed using a structured multi-stage protocol that included repeated radical debridement to achieve a viable wound bed, prolonged NPWT to promote granulation tissue formation, reduce edema, and control exudation, along with gradual wound edge approximation using retention sutures. Targeted antimicrobial therapy was administered according to microbiological findings, followed by delayed split-thickness skin grafting and a structured rehabilitation program. Complete graft integration was achieved without purulent-septic complications. At 6.5 months of follow-up, the patient demonstrated restoration of full weight-bearing capacity, preservation of plantar contour and biomechanics, stable gait, and a satisfactory functional outcome without chronic ulceration, infection, or neuropathic pain. This case highlights the clinical value of an integrated, stepwise reconstructive approach in managing severe blast-induced plantar defects and underscores the importance of prolonged NPWT as a key modality for optimizing wound bed preparation and improving reconstructive outcomes when critical anatomical structures are preserved.